American journal of kidney diseases : the official journal of the National Kidney Foundation
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Randomized Controlled Trial Multicenter Study Comparative Study
Canadian randomized trial of hemoglobin maintenance to prevent or delay left ventricular mass growth in patients with CKD.
This randomized clinical trial is designed to assess whether the prevention and/or correction of anemia, by immediate versus delayed treatment with erythropoietin alfa in patients with chronic kidney disease, would delay left ventricular (LV) growth. Study design and sample size calculations were based on previously published Canadian data. ⋯ This trial describes disparity between observational and randomized controlled trial data: observed and randomly assigned Hgb level and LVMI are not linked; thus, there is strong evidence that the association between Hgb level and LVMI likely is not causal. Large randomized controlled trials with unselected patients, using morbidity and mortality as outcomes, are needed.
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Citrate-based continuous venovenous hemofiltration (CVVH) replacement fluids provide effective and simple regional anticoagulation. However, concern over toxicity has limited citrate use, especially at the high filtration rates advocated for better outcomes. We used volumes of 72 L/d in patients at high risk for bleeding and investigated the treatment's efficacy, safety, and clinical results, especially with regard to nutrition supplementation. ⋯ CVVH with 3 L/h of citrate-based replacement fluid is a safe, efficient, and simple technique in patients at high risk for bleeding. It allows superb control of uremia and fluid balance and thereby permits aggressive nutritional support.
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Comparative Study Controlled Clinical Trial
Comparison and interpretation of urinalysis performed by a nephrologist versus a hospital-based clinical laboratory.
Urinalysis (UA) is considered the most important laboratory test in evaluating patients with kidney disease. Anecdotally, we have observed differences between results of UA performed by nephrologists compared with those performed by certified medical technologists or clinical laboratory scientists that could affect a clinician's diagnosis. Whether there are differences between UA performed by the clinical laboratory and that performed by a nephrologist was determined, and accuracy of diagnosis based on interpretation of the UA was compared. ⋯ A nephrologist is more likely to recognize the presence of RTE cells, granular casts, RTE casts, and dysmorphic red blood cells in urine. The laboratory may be reporting RTE cells incorrectly as squamous epithelial cells. Nephrologist-performed UA is superior to laboratory-performed UA in determining the correct diagnosis.